Nasal pillows are a continuous positive airway pressure (CPAP) interface designed to deliver pressurized air directly into the nostrils. They are the least physically invasive mask option, offering minimal contact that enhances comfort and reduces feelings of claustrophobia. A correct fit is essential for effective therapy. A poor seal causes air leaks, compromising prescribed pressure delivery, and an ill-fitting pillow can cause skin irritation, pressure sores, and disrupt sleep.
Sizing and Selection: Finding the Right Fit
Sizing nasal pillows is based on the diameter of the nostril opening, not the width of the nose bridge. Manufacturers typically provide sizing templates or gauges to help users determine the best fit before purchase. These templates help gauge which pillow size—often labeled small, medium, or large—will create an effective seal.
The goal is to select the smallest pillow that creates a secure seal without causing discomfort or stretching the skin. When inserted, the pillow should rest gently just inside the nostril opening, sealing lightly against the internal walls. If the pillow is too small, it inserts too deeply and causes irritation. A pillow that is too large presses uncomfortably against the outside of the nostril, but a proper fit ensures pressurized air is directed efficiently into the airway.
Adjusting for Optimal Seal and Comfort
Once the correct pillow size is selected, fine-tuning the headgear is the next step toward achieving an optimal seal and comfort. The headgear should follow the “Goldilocks” principle: it must be snug enough to prevent leaks but not so tight that it leaves deep pressure marks. Over-tightening is a common mistake that can distort the pillow shape and cause leaks, in addition to creating discomfort.
To adjust the fit, loosen the headgear straps and gently insert the pillows into the nostrils, ensuring they sit horizontally. It is most effective to lie down in the typical sleeping position before making final adjustments, as facial contours change when horizontal. With the CPAP machine running, slowly tighten the straps until the airflow noise from any leaks ceases. This micro-adjustment process, performed while the mask is under pressure, confirms the seal in the actual sleeping posture.
Troubleshooting Common Nasal Pillow Issues
Persistent air leaks are a frequent problem, often fixed by slight repositioning rather than tightening. If air is escaping, pull the mask slightly away from the face and gently let it settle back into position to allow the pillow to re-seat itself. If leaks continue, check the pillow for signs of wear, such as tears or softening of the silicone, which indicate replacement is needed.
Pressure marks or skin irritation are signs of overtightening the headgear straps. Loosening the straps and ensuring the pillow size is correct addresses this, but topical barrier creams or mask liners can also provide protection. For slippage during the night, assess the tension of the top headgear strap, which runs over the crown of the head. Adequate tension on this strap helps stabilize the mask interface and prevents the pillows from pulling out of the nostrils during movement.